[104-10222-10038.pdf — page 218]
# DECLARATION OF APPOINTEEThis form is to be completed before entrance on duty. Question 3 is to be answered in all cases, otherwise answer only those questions which require an answer different from that given to the corresponding questions on your application form. If no answers are different, write "NONE" in Item 10, below. Any false statement in this declaration will be grounds for cancellation of application or dismissal after appointment. Impersonation is a criminal offense and will be prosecuted accordingly.1. PREZENT ALKARLSS (street and number, city and State)212 FLORIDA AVE. Nu!, WASHINGTON, D.C.2. 60 DATE SP BIRTH (8) PLACE OF BIRTH (city of town and Stats or country)3. (A) IN CASE OF EMERGENCY PLEASE NOTIFY (B) RELATIONSHIP (C) STREET AND NUMBER, CITY AND STATE (D) TELEPHONE HO.MRS. David W. Biegley mother 2005 SOLEDAD Arr GLENLOJE 5LA JOLLA CALIFORNIA 4434. DOES THE UNITED STATES GOVERNMENT EMPLOY, IN A CIVILIAN CAPACITY, ANY RELATIVE OF YOURS (EITHER BY BLOOD OR MARRIAGE) WITH WHOM YOU LIVE OR HAVE LIVED WITHIN   THE PROT IS MORT WS? YES NON, for each such relative will in the blanks below. If additional space is necessary, complete under Item 10.| NAME | POST OFFICE ADDRESS (Give street number, if any) | (1) POSITION (2) TEMPORARY OR NOT DEPARTMENT OR AGENCY IN WHICH EMPLOYED | RELATION SHIP | MAR RIED SINGLE (Cheak one). || ---- | ------------------------------------------------ | ------------------------------------------------------------------------ | ------------- | ---------------------------- || 1.   |                                                  |                                                                          |               |                              || 2.   |                                                  |                                                                          |               |                              || 3.   |                                                  |                                                                          |               |                              || 4.   |                                                  |                                                                          |               |                              || 5.   |                                                  |                                                                          |               |                              || 6.   |                                                  |                                                                          |               |                              |INDICATE "YES" OR "NO" ANSWER BY PLACING "X" IN PROPER COLUMN5. ARE YOU A CITIZEN OF OR DO YOU OWE ALLEGIANCE TO THE UNITED STATEST.. YES NO[X]6. ARE FOR AN OFFICIAL OR EMPLOYEE OF ANY STATE, TERRITORY, COAUNTY, OR MURGOPALITYIIf your answer is "You", give details in Item 10.7. DO YOU KELIVE ANY ANNUITY FROM THE UNITED STATES OR DISTRICT OF αλώνει οYFRAUENT UNDER ANY RETIREMENT ACT OR ANY PENTION OR رف آنTION OR MILITARY OR NAVAL SERVICE...........Ilyost answer to You", dive in Storm 10 reason for retirement. tass te, ege, optional disability, or by reasori of voluntary CA Susitary separation after 3 yours' servico; amount of setisepciaert gay, and under what retirement act; and rating. if retired Iscan military of naval servica.8. WAVE EVER BEEN DISCHARGED, OR FORCED TO RESIGN, FOR MISSROUCT GRASTCAY SERVICE FROM ANY POSITIONT...H your arrower is "You", dive in Item 10 the name and address ww, dots, and reason in each caso.9. IFTH BESTHDAY HAVE VOU FVFP BEEN ARRPATED INDICTIO RIES TO COURS AS A DEFENDANT IN A CRIMINAL PROCEELIAS, ся COSMO ORIMPRISONED, OR PLACED ON FISBATH, OR HAVE YO ΕΛ END TO DEPOSIT BAIL OR COLLATERAL FOR THE VIVAتره CHISTAN POLICE REGULATION, OR ORDNANCE (EXCLUS MINOR, T۴۶۲۶۱۷ WOLATEMS FOR WHICH A FINE OR FORFEITURE OF STORLESS WAS IMPOSELI!! your answer is "Yes", liet all such cases under Item 10 Gire in each case: (!) The date; (2) the nature of the offense راعات منn; (3) the name and location of the court: (4) she penalty speed, if any, of other disposition of the case. if epposited, youue Angerprints will he taken.10. SPACE FOR DETAILED ANSWERS TO OTHER QUESTIONSITEM NO WRITE IN LEFT COLUMN NUMBERS OF ITEMS TO WHICH DETAILED ANSWERS APPLYINSTRUCTIONS TO APPOINTING OFFICERThe apprinting officer before whom the forencing certificate is made adull deterone eius ora entisfaction that the appointinent wrasid be in conformance with the Civil Service Act, applicable Civil Service Rules and Regلحه مامان atts of Congress pertaining to appointment,Thos Corso abund be checked for holding of office, pension, suitablity la een cecten wuh any record of recent discharge or arrest, sad perticularly for the khors:(1) iceauty of appointee. The appointee's signature and handwriting age toeα απαίnes antes eins mitha The physical appearance may be checked against the medical certificate, The pastet stay aloo be qurationed ca his personal history for agreement with a prevara(2) Age despite age limits have been established for the position, it should beard that applicant is not outarde the age range for appointmeat. Veti ermication is made, the appeatmen nay not be consummated.0. L. creat (3) Citizenship. The appointing officer is responsible for observing the twecalp provisions of (1) Service Rules (7) appropriation acts, Fovea 61 constitutes on affidavit for both purposes and is acceptable proof of twenship status in the absence of conflicting evidence. In doubtful cases the wtmeat should not be consummated until clearance has been secured from the certifying office of the Civil Servine Commissum,(4) Members of Family. Section 9 of the Civil Service Act provides that whenever there are already two or more members of a family serving umier probational or permanent appointment in the competitive servue, no other meaider of sach faimly is cliquide for probational or permanent pontiment in the competitive service. The appointstents of persons enotied to veteran preferrace are not subject to this requirement. The merobers-of-family provision Ars not apply to temporary appomeniente Doubtful cars may be referred to the appropriate office of the Service Communica for decision.15-5310!